Case Report: Adjuvant Therapy with a High Dose of Mitotane for Adrenocortical Carcinoma in a 4-year-old Boy

This report concerns control of adrenocortical carcinoma in a 4-yr-old boy byadjuvant mitotane therapy. He presented precocious puberty and was diagnosed withadrenocortical carcinoma. He underwent surgical resection, and adjuvant mitotane therapywas initiated, leading to a final dose of 5.0 g/day. Despite monitoring of the plasmamitotane level, encephalopathy developed 5 mo after initiation. Although he recovered fromthe encephalopathy, careful follow-up of his growth and development is necessary. On theother hand, he has been free of recurrence and metastases for 3 yr since discontinuationof mitotane. A high dose of mitotane is potentially effective as an adjuvant chemotherapyfor adrenocortical carcinoma, although optimal and safe usage needs to be established forchildren.